Executive Summary of Key Concepts
Executive Summary of Key Concepts
Research The Influence of Flooring on Environmental Stressors: A Study of Three Flooring Materials in a Hospital Debra D. Harris. A hospital is a stressful environment for patients as well as healthcare workers. For the patient, concerns about their health and medical treatment, being away from home, missing work or school are all stressors that impact their wellbeing. The design of the physical environment to minimize external stressors can provide a supportive environment that may lessen or at least may not contribute to the stress load for those in the healthcare facility. This study evaluated flooring materials by comparing noise levels over long periods of time to determine whether carpet tiles or rubber flooring significantly reduced the sound levels when compared to terrazzo. Then, the study assessed patient reports of how quiet the area around their room was a night to determine if the results of the sound study influenced patient responses. In addition, healthcare workers participated in a three phase study to evaluate their responses to underfoot comfort, differences in sound levels, and self-reported pain to determine other factors that contribute to the consideration of soft, resilient and hard flooring materials for patient unit corridors. The findings showed that there was a significant difference for sound levels between the three flooring types. Preferences for flooring type among healthcare workers changed over the course of the study. Patient responses were in alignment with the sound meter data, indicating a realized difference, a key factor for improving patient satisfaction.
Health Environments Research & Design Journal 2015, Vol. 8(3) 3-5 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1937586715583293 herd.sagepub.com
Art Viewing Directives in Hospital Settings Effect on Mood Rainbow T. H. Ho, Jordan S. Potash, Fan Fang, and Judy Rollins. This study aimed to determine the therapeutic effect that viewing directives may have for patients, visitors, and staff who encounter art in a hospital. In addition, the study aimed to understand how these participants responded to an exhibit created by medical students on the theme of empathy for pain and suffering. The quantitative data provided modest support that viewing directives helped to increase mood. The directives may have helped viewers to structure the art viewing experience, which offered opportunities for reflection. Such directives offer an efficient and costeffective strategy for use in hospitals. Offering opportunities to view art on existential themes were of interest to patients, as they saw such art as a mirror for their current concerns. Hospital staff, however, were concerned about these themes and voiced preferences for art that was peaceful. The findings lend support to the notion that there may not be any one particular style of art that is best suited for hospitals, but rather the importance of helping viewers learn how to engage with art.
Identifying Elements of the Health Care Environment That Contribute to Wayfinding Debajyoti Pati, Thomas E. Harvey Jr, Douglas A. Willis, and Sipra Pati. While navigating complex health care facilities has been acknowledged as a critical issue by health care administrators for decades, the main focus has been on sign and map systems. The fact of interest as well as concern, however,
4
is that wayfinding remains a critical problem despite numerous advances in signage systems, staff support, and technology. The investigating team comprising of researchers from a large research university, an international health care design firm, and a large tertiary-care community hospital, zeroed in on the most basic question that needed examination: ‘‘What kinds of information do people seek from the ambient physical environment when navigating in complex buildings?’’ Study findings suggest that beside signs and maps, interior and architectural features play a crucial role in the ‘‘Aha-Moments’’—the moments best described as that when people comprehend where they are and where the destination is. This article discusses physical design attributes manipulated by architects and interior designers and their role in aiding navigation for facility users. The findings provide a foundation to aid in decision making regarding allocating capital toward different wayfinding strategies.
Infection Control in Design and Construction Work William H. Collinge. This article explores how the essential management of infection control issues through the hospital and medical facility construction project life cycle can be compromised by the intangibility and representational indistinctness of infection control requirements. Despite the existence of definitive regulations and guidance, this article notes how infection control requirements present designers, contractors, and the client with challenges that potentially result in delays, stoppages, and redesign work. Using empirical data from a study of requirement communications occurring on National Health Service hospital construction projects in the United Kingdom, this article explores how the meaning of infection control requirements can be obscured or masked by project resources through different phases of hospital construction project work. It is argued that a forward-looking managerial approach that facilitates mutual knowledge sharing interactions and a preemptive identification of issues can prevent infection control from becoming a problem. This article calls for the nature of infection control in
Health Environments Research & Design Journal 8(3)
design and construction work to be recognized while referring practitioners to the valuable and vital guidance already published in this area.
Housing Choices and Care Home Design for People With Dementia Karim Hadjri, Cliona Rooney, and Verity Faith. It is known that older people desire to age in their own homes whenever possible, but this is not always possible due to the challenge of adapting these environments to ensure and maintain independence, accessibility, and social connectivity. There is no doubt that this is extremely challenging for people with dementia given the risk associated with living alone. For people with dementia, a move to a new environment is often a stressful experience that causes shock, withdrawal, and anger. This is why there is need for more inclusive forms of collective housing, and for more research to develop more fitting long term housing options for people with dementia. Through a review of existing literature and interviews with managers of 22 care homes in the UK, the paper concludes that generally the choice of care homes relates to the atmosphere of a home as some occupants favor a homely or relaxing environment and others prefer more dynamic settings. Three themes emerged as potentially important in leading to a more enabling environment; these are appropriate level of care, a good atmosphere, and design quality within the care home.
Case Studies Reinventing Emergency Department (ED) Flow via Health Care Delivery Science Christopher DeFlitch, Glenn Geeting, and Harold L. Paz. Overcrowding of EDs is a serious quality and access problem, but few sustainable solutions have been proposed. This case study examines an academic health center ED that was over capacity and experiencing continued increases in patient volumes, with limited physical space for expansion. This health center increased ED capacity and efficiency by utilizing health care engineering processes to examine current practices and make adjustments to patient and staffing
Executive Summary of Key Concepts
flows, while adding only modest space and human resources. After mapping ED arrival and management processes to understand workflow and identify bottlenecks, we created a patient flow map to identify processes contributing to impaired ED flow and inefficiency. A new model of emergency care delivery, physician-directed queuing, was developed. Providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. After 12 months of implementation, ED efficiency metrics improved from baseline conditions. The number of ED beds increased by eight and nursing hours increased modestly, but ED physician staffing was stable. Patient satisfaction increased significantly. Our experience suggests that health care engineering processes can be used to improve ED efficiency with a moderate outlay of resources.
5
Case Study: Design May Influence Use of Seclusion and Restraint John M. McCurdy, James R. Haliburton, Hardik C. Yadav, Allison M. Yoder, Lindsey R. Norton, Josef A. Froehlich, Harpreet Kaur, Nicholas F. Kramer, Ayesha Silman, Brian J. Quinn, Sharon Pudlo, Christina Butler Terrell, and Rif S. El-Mallakh. Open unit design in psychiatry has been advocated as design features that reduce obstacles between nursing staff and patients. There are no studies that document that open unit design improve outcome in psychiatric units. Open unit design on psychiatric units may have unintended consequences. In a dedicated psychiatric emergency service, restricting patients’ access from the waiting area to the evaluation and holding areas was associated with a reduction in agitation and the need for seclusion and restraints. While this may be unique to emergency psychiatric areas, limitations to open design features need to be considered in some psychiatric settings.
Executive Summary of Key Concepts
Research The Influence of Flooring on Environmental Stressors: A Study of Three Flooring Materials in a Hospital Debra D. Harris. A hospital is a stressful environment for patients as well as healthcare workers. For the patient, concerns about their health and medical treatment, being away from home, missing work or school are all stressors that impact their wellbeing. The design of the physical environment to minimize external stressors can provide a supportive environment that may lessen or at least may not contribute to the stress load for those in the healthcare facility. This study evaluated flooring materials by comparing noise levels over long periods of time to determine whether carpet tiles or rubber flooring significantly reduced the sound levels when compared to terrazzo. Then, the study assessed patient reports of how quiet the area around their room was a night to determine if the results of the sound study influenced patient responses. In addition, healthcare workers participated in a three phase study to evaluate their responses to underfoot comfort, differences in sound levels, and self-reported pain to determine other factors that contribute to the consideration of soft, resilient and hard flooring materials for patient unit corridors. The findings showed that there was a significant difference for sound levels between the three flooring types. Preferences for flooring type among healthcare workers changed over the course of the study. Patient responses were in alignment with the sound meter data, indicating a realized difference, a key factor for improving patient satisfaction.
Health Environments Research & Design Journal 2015, Vol. 8(3) 3-5 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1937586715583293 herd.sagepub.com
Art Viewing Directives in Hospital Settings Effect on Mood Rainbow T. H. Ho, Jordan S. Potash, Fan Fang, and Judy Rollins. This study aimed to determine the therapeutic effect that viewing directives may have for patients, visitors, and staff who encounter art in a hospital. In addition, the study aimed to understand how these participants responded to an exhibit created by medical students on the theme of empathy for pain and suffering. The quantitative data provided modest support that viewing directives helped to increase mood. The directives may have helped viewers to structure the art viewing experience, which offered opportunities for reflection. Such directives offer an efficient and costeffective strategy for use in hospitals. Offering opportunities to view art on existential themes were of interest to patients, as they saw such art as a mirror for their current concerns. Hospital staff, however, were concerned about these themes and voiced preferences for art that was peaceful. The findings lend support to the notion that there may not be any one particular style of art that is best suited for hospitals, but rather the importance of helping viewers learn how to engage with art.
Identifying Elements of the Health Care Environment That Contribute to Wayfinding Debajyoti Pati, Thomas E. Harvey Jr, Douglas A. Willis, and Sipra Pati. While navigating complex health care facilities has been acknowledged as a critical issue by health care administrators for decades, the main focus has been on sign and map systems. The fact of interest as well as concern, however,
4
is that wayfinding remains a critical problem despite numerous advances in signage systems, staff support, and technology. The investigating team comprising of researchers from a large research university, an international health care design firm, and a large tertiary-care community hospital, zeroed in on the most basic question that needed examination: ‘‘What kinds of information do people seek from the ambient physical environment when navigating in complex buildings?’’ Study findings suggest that beside signs and maps, interior and architectural features play a crucial role in the ‘‘Aha-Moments’’—the moments best described as that when people comprehend where they are and where the destination is. This article discusses physical design attributes manipulated by architects and interior designers and their role in aiding navigation for facility users. The findings provide a foundation to aid in decision making regarding allocating capital toward different wayfinding strategies.
Infection Control in Design and Construction Work William H. Collinge. This article explores how the essential management of infection control issues through the hospital and medical facility construction project life cycle can be compromised by the intangibility and representational indistinctness of infection control requirements. Despite the existence of definitive regulations and guidance, this article notes how infection control requirements present designers, contractors, and the client with challenges that potentially result in delays, stoppages, and redesign work. Using empirical data from a study of requirement communications occurring on National Health Service hospital construction projects in the United Kingdom, this article explores how the meaning of infection control requirements can be obscured or masked by project resources through different phases of hospital construction project work. It is argued that a forward-looking managerial approach that facilitates mutual knowledge sharing interactions and a preemptive identification of issues can prevent infection control from becoming a problem. This article calls for the nature of infection control in
Health Environments Research & Design Journal 8(3)
design and construction work to be recognized while referring practitioners to the valuable and vital guidance already published in this area.
Housing Choices and Care Home Design for People With Dementia Karim Hadjri, Cliona Rooney, and Verity Faith. It is known that older people desire to age in their own homes whenever possible, but this is not always possible due to the challenge of adapting these environments to ensure and maintain independence, accessibility, and social connectivity. There is no doubt that this is extremely challenging for people with dementia given the risk associated with living alone. For people with dementia, a move to a new environment is often a stressful experience that causes shock, withdrawal, and anger. This is why there is need for more inclusive forms of collective housing, and for more research to develop more fitting long term housing options for people with dementia. Through a review of existing literature and interviews with managers of 22 care homes in the UK, the paper concludes that generally the choice of care homes relates to the atmosphere of a home as some occupants favor a homely or relaxing environment and others prefer more dynamic settings. Three themes emerged as potentially important in leading to a more enabling environment; these are appropriate level of care, a good atmosphere, and design quality within the care home.
Case Studies Reinventing Emergency Department (ED) Flow via Health Care Delivery Science Christopher DeFlitch, Glenn Geeting, and Harold L. Paz. Overcrowding of EDs is a serious quality and access problem, but few sustainable solutions have been proposed. This case study examines an academic health center ED that was over capacity and experiencing continued increases in patient volumes, with limited physical space for expansion. This health center increased ED capacity and efficiency by utilizing health care engineering processes to examine current practices and make adjustments to patient and staffing
Executive Summary of Key Concepts
flows, while adding only modest space and human resources. After mapping ED arrival and management processes to understand workflow and identify bottlenecks, we created a patient flow map to identify processes contributing to impaired ED flow and inefficiency. A new model of emergency care delivery, physician-directed queuing, was developed. Providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. After 12 months of implementation, ED efficiency metrics improved from baseline conditions. The number of ED beds increased by eight and nursing hours increased modestly, but ED physician staffing was stable. Patient satisfaction increased significantly. Our experience suggests that health care engineering processes can be used to improve ED efficiency with a moderate outlay of resources.
5
Case Study: Design May Influence Use of Seclusion and Restraint John M. McCurdy, James R. Haliburton, Hardik C. Yadav, Allison M. Yoder, Lindsey R. Norton, Josef A. Froehlich, Harpreet Kaur, Nicholas F. Kramer, Ayesha Silman, Brian J. Quinn, Sharon Pudlo, Christina Butler Terrell, and Rif S. El-Mallakh. Open unit design in psychiatry has been advocated as design features that reduce obstacles between nursing staff and patients. There are no studies that document that open unit design improve outcome in psychiatric units. Open unit design on psychiatric units may have unintended consequences. In a dedicated psychiatric emergency service, restricting patients’ access from the waiting area to the evaluation and holding areas was associated with a reduction in agitation and the need for seclusion and restraints. While this may be unique to emergency psychiatric areas, limitations to open design features need to be considered in some psychiatric settings.
